American Journal of Gastroenterology最新文献

{"title":"Dupilumab Improves Esophageal Distensibility in EoE: 24-Week Results From the REMODEL Randomized Trial.","authors":"Evan S Dellon, Dustin A Carlson, Thomas Greuter, Margaret H Collins, Ali Lankarani, Neetu Talreja, Karthik Ravi, Joaquim Simões Neto, Waqqas Afif, Nirmala P Gonsalves, Kristle L Lynch, Sherif Zaghloul, Danen Cunoosamy, Sandy R Durrani, Mei Zhang, Bram P Raphael, James T Angello, Amr Radwan, Cristina Almansa, Luc Biedermann","doi":"10.14309/ajg.0000000000004227","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004227","url":null,"abstract":"<p><strong>Objectives: </strong>Eosinophilic esophagitis (EoE) is a chronic, often progressive, type 2 inflammatory disease characterized by eosinophilic infiltration, and esophageal narrowing and dysfunction. This analysis presents 24-week outcomes from the phase 4 REMODEL trial, evaluating long-term esophageal distensibility in adults with EoE.</p><p><strong>Methods: </strong>Adult EoE patients were randomized 2:1 to dupilumab 300 mg once weekly or placebo. Patients were assessed overall and by low (<17 mm) and normal (≥17 mm) baseline distensibility plateau (DP) subgroups. Endpoints at week (W) 24 included: absolute change from baseline in esophageal DP diameter on endoluminal functional lumen imaging probe (primary), and changes from baseline in Endoscopic Reference Scores (EREFS) and EoE histology scoring system (EoEHSS) grade/stage scores. Safety was assessed.</p><p><strong>Results: </strong>Sixty-nine patients (46 dupilumab, 23 placebo) were randomized. Evaluable patients in the DP subgroups were: 30 low (19 dupilumab, 11 placebo) and 33 normal (22 dupilumab, 11 placebo) baseline DP. At W24 overall, dupilumab improved esophageal DP diameter vs placebo; least squares mean (LSM) (±SE) absolute change from baseline: +1.28 mm (0.29) and -0.01 mm (0.42); LSM difference: +1.30 mm (95% CI: 0.31, 2.29; P < 0.05). LSM difference vs placebo in the low DP subgroup was +2.21 mm (95% CI: 0.78, 3.63; nominal P = 0.0024). Overall LSM difference for dupilumab vs placebo was -4.96 (-6.06, -3.85) in EREFS, and -0.71 (-0.86, -0.57) and -0.65 (-0.80, -0.51) in EoEHSS grade and stage scores, respectively (all P < 0.0001). No new safety signals were identified.</p><p><strong>Conclusion: </strong>Dupilumab significantly improved W24 esophageal distensibility outcomes, with greater improvements in the low baseline DP subgroup compared to the overall population. (ClinicalTrials.gov, number NCT06101095).</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural history of children aged 1-12 years with chronic hepatitis B: A multicenter study.","authors":"Xue-Jing Yu, Sheng-Li Ma, Yu-Zhuo Wu, Guo-Tao Li, Yan-Qin Ai, Na-Na Meng, Zheng-Yan Wen, Zhuang-Zhuang Zhai, Ya-Jie Pan, Qing-Lei Zeng","doi":"10.14309/ajg.0000000000004221","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004221","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical management of relapse in type 1 autoimmune pancreatitis: a systematic review and meta-analysis.","authors":"Zonghao Liu, Yixiao Wang, Xiaonan Shen, Chenxiao Liu, Tianyi Che, Wanqian Xu, Yao Zhang, Henglong Li, Can Li, Venkata Akshintala, Chunhua Zhou, Duowu Zou","doi":"10.14309/ajg.0000000000004230","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004230","url":null,"abstract":"<p><strong>Objectives: </strong>Type 1 autoimmune pancreatitis (AIP) has a high risk of relapse, but evidence to guide management is limited. We evaluated relapse patterns, predictors, and the comparative effectiveness of maintenance and relapse treatment.</p><p><strong>Methods: </strong>We systematically reviewed studies of patients with type 1 AIP receiving maintenance treatment or relapse treatment. Single-arm, pairwise, and Bayesian network meta-analyses were performed to synthesize relapse outcomes and compare treatment strategies.</p><p><strong>Results: </strong>Thirty-seven studies involving 5,742 patients, including two randomized controlled trials and thirty-five cohort studies. Maintenance therapy reduced relapse risk (RR, 0.58; 95% CI, 0.46-0.72). Among Asian cohorts, longer-term glucocorticoid therapy was associated with a lower risk than shorter-term therapy (RR, 0.46; 95% CI, 0.23-0.89). Maintenance glucocorticoid doses of ≥ 5 mg/d showed a trend toward a lower relapse risk compared with doses of < 5 mg/d (RR, 0.61; 95% CI, 0.36-1.04). Relapse risk accumulated over time, and the pancreas was the predominant relapse site (71%). Male sex, jaundice, diabetes mellitus, elevated serum IgG4 (> 1 × ULN), bile duct involvement, and other organ involvement were associated with increased relapse risk. For relapse treatment, rituximab showed the most favorable estimates, followed by glucocorticoids plus immunomodulators, but most network comparisons were based on low- or very-low-certainty evidence.</p><p><strong>Conclusions: </strong>Maintenance therapy is associated with a lower relapse risk in type 1 AIP, with longer-term glucocorticoid therapy showing benefit in Asian cohorts. Relapse risk accumulates over time and predominantly involves the pancreatobiliary system. Rituximab may provide favorable outcomes for relapse treatment, but its comparative superiority remains uncertain because of low-certainty evidence.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two Bleeds, One Source: A Rare case of hematochezia and vaginal bleeding from an ulcerated anovaginal fistula with a pulsatile visible vessel.","authors":"Sydney Power, Sydney B Greenberg","doi":"10.14309/ajg.0000000000004229","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004229","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tobacco Use is Associated with Anorectal Sensorimotor Dysfunction and Greater Fecal Incontinence Severity.","authors":"Brent A Hiramoto, Susie Lee, Catherine Y Wang, Jonah Blumenthal, Nayna A Lodhia, Walter W Chan","doi":"10.14309/ajg.0000000000004231","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004231","url":null,"abstract":"<p><strong>Background: </strong>Tobacco use has been associated with a range of digestive symptoms and gastrointestinal smooth muscle dysfunction. However, the impact of tobacco use on fecal incontinence (FI) and anorectal function remains unclear. We aimed to evaluate whether tobacco use disrupts anorectal sensorimotor function and affects FI severity.</p><p><strong>Methods: </strong>Consecutive patients referred for high-resolution anorectal manometry (HRAM) at a tertiary center were included. Validated survey instruments (GI-PROMIS, 12-item short-form health survey [SF-12], global symptom severity) and smoking status were prospectively collected at time of testing. HRAM metrics and London classification diagnoses were compared according to tobacco exposure. Multivariable analyses adjusting for potential confounders were performed.</p><p><strong>Results: </strong>Among 385 patients (81% female; mean age 53.4) enrolled, 112 (29.1%) reported tobacco use. Compared to non-smokers, tobacco users had greater FI severity on GI-PROMIS (6.06±0.28 vs. 5.29±0.17, p=0.017), worse mental component score on SF-12 (42.6±1.5 vs 46.7±1.0, p=0.028), lower anal sphincter resting pressure (52.6±2.4 vs 65.9±1.8 mmHg, p<0.0001), more rectal hypersensitivity (71.4% vs. 60.8%, p=0.049), and higher prevalence of anal hypotension ± hypocontractility per London classification (34.9% vs. 23.1%, p=0.018). On multivariable general linear regression, tobacco use independently correlated with worse FI symptoms (β=1.28, p=0.035) and lower anal resting pressure (β=-8.57, p=0.018). Tobacco use also remained a significant predictor for rectal hypersensitivity on logistic regression (OR 2.35, 95% CI:1.20-4.62, p=0.013).</p><p><strong>Conclusions: </strong>Tobacco use is independently associated with more severe FI symptoms, weaker anal sphincter tone, and increased rectal hypersensitivity . Further studies should assess reversibility of the observed anorectal sensorimotor dysfunction with tobacco cessation.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual cause of gastric outlet obstruction.","authors":"Sebastian Zundler, Annemarie Gehring","doi":"10.14309/ajg.0000000000004224","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004224","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Evidence-Based Approach to Zenker's Diverticulum: From Diagnosis to Tailored Treatment.","authors":"Marina Kim, Jennifer M Kolb, Mihir S Wagh","doi":"10.14309/ajg.0000000000004228","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004228","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic Use Linked to Worse Outcomes in Patients With Gastrointestinal and Liver Cancer on Immune Checkpoint Inhibitors: A Meta-Analysis.","authors":"Mohammad Saeid Rezaee-Zavareh, Hamidreza Karimi-Sari, Peyvand Parhizkar Roudsari, Osama Khattab, Abdelrahman M Attia, Pojsakorn Danpanichkul, Soo Young Hwang, Jessica S Liu, Tamar Yalda, Pin-Jung Chen, Jun Gong, Cristina R Ferrone, Nicole E Rich, Neehar D Parikh, David J Pinato, Amit G Singal, Ju Dong Yang","doi":"10.14309/ajg.0000000000003956","DOIUrl":"10.14309/ajg.0000000000003956","url":null,"abstract":"<p><strong>Introduction: </strong>Immune checkpoint inhibitors (ICIs) are increasingly used in gastrointestinal and liver cancers. However, antibiotic-induced gut microbiota disruption may influence ICI effectiveness. The objective of this study was to evaluate association between antibiotic use and clinical outcomes among patients with gastrointestinal and liver cancers receiving ICI therapy.</p><p><strong>Methods: </strong>In this meta-analysis, we searched studies involving adults with gastrointestinal or liver cancers treated with ICIs, comparing outcomes between patients with and without antibiotic use. Eligible studies reported hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) for overall survival (OS), progression-free survival (PFS), objective response rate, or disease control rate. Random-effects models were used for pooled analyses.</p><p><strong>Results: </strong>Twenty-eight studies were included. Antibiotic use was associated with worse OS (HR 1.56; 95% CI: 1.23-1.98; I2 = 87.3%), PFS (HR 1.48; 95% CI: 1.15-1.90; I2 = 88.3%), and disease control rate (OR 0.55; 95% CI: 0.33-0.90; I2 = 65.0%), but no significant difference in objective response rate (OR 1.01; 95% CI: 0.78-1.31; I2 = 0%). Results were consistent in subgroup analyses by ICI type and timing of antibiotic administration. Antibiotic use was associated with worse OS and PFS in hepatocellular carcinoma (HR for OS: 1.49; 95% CI: 1.24-1.79; HR for PFS: 1.25; 95% CI: 1.01-1.56) and upper gastrointestinal cancers (HR for OS: 2.40; 95% CI: 1.48-3.90; HR for PFS: 2.15; 95% CI: 1.18-3.91), whereas colorectal cancer studies showed improved OS (HR: 0.58; 95% CI: 0.45-0.75).</p><p><strong>Discussion: </strong>Antibiotic use is associated with worse outcomes in patients with gastrointestinal or liver cancer receiving ICIs and should be carefully justified. Prospective studies are needed to validate these results.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2562-2574"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146163651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors of Proximal and Distal Advanced Colorectal Conventional and Serrated Neoplasia in Adults Younger Than 50 Years of Age.","authors":"Darius J Javidi, Lynn F Butterly, Christopher I Amos, Todd A Mackenzie, Christina M Robinson, Joseph C Anderson","doi":"10.14309/ajg.0000000000003950","DOIUrl":"10.14309/ajg.0000000000003950","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal cancer (CRC) has increased in adults younger than 50 years of age, particularly in the distal colon. Data examining the risk factors of advanced colorectal neoplasia in young adults as stratified by anatomic location have important implications for screening and risk modification.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of data from New Hampshire Colonoscopy Registry participants younger than 50 years of age. We developed an average-risk equivalent sample by excluding patients with IBD, genetic syndromes, and those with indications predictive of colorectal neoplasia such as anemia or hematochezia. Our outcomes were left-sided and right-sided advanced conventional neoplasia (≥1 cm; villous or high grade dysplasia), advanced serrated neoplasia (>1 cm or with dysplasia), and having synchronous advanced neoplasia and sessile serrated polyps/lesions.</p><p><strong>Results: </strong>We included 14,369 patients, younger than 50 years at colonoscopy. Increased risk of left-sided advanced neoplasia was observed with current smoking (odds ratio [OR] 2.14), male sex (OR 1.66), older age (OR 1.07), and higher body mass index (BMI) (OR 1.02). Right-sided advanced neoplasia was associated with smoking (OR 1.71), family history of CRC (OR 1.62), older age (OR 1.07), and higher BMI (OR 1.03). Left advanced serrated neoplasia was associated with older age (OR 1.08), and higher BMI (OR 1.05). Left-sided synchronous lesions were associated with smoking (OR 2.33), older age (OR 1.08), and higher BMI (OR 1.04). Right-sided synchronous lesions were associated with family history of CRC (OR 1.67). The lower bound of the 95% CI for each OR was ＞1.</p><p><strong>Discussion: </strong>We identified modifiable risk factors including current smoking and higher BMI in young adults with right and left-sided colorectal polyps. Older age, male sex, and family history were nonmodifiable predictors. These data can help to inform screening and prevention of CRC in young adults.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2555-2561"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146163749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Outcomes of Flexible Endoscopy, Rigid Endoscopy, and Open Surgery for the Zenker Diverticulum Repair: A Retrospective Matched Cohort Study.","authors":"Akua Nuako, Steven Steinway, Bianca Zussino, Alexandra Goad, Michele B Ryan, Christopher C Thompson","doi":"10.14309/ajg.0000000000003915","DOIUrl":"10.14309/ajg.0000000000003915","url":null,"abstract":"<p><strong>Introduction: </strong>Flexible endoscopy (FE), rigid endoscopy (RE), and open surgery (OS) are established treatments of Zenker diverticulum (ZD); however, comparative data on their clinical outcomes remain limited and inconsistent. We conducted the first multicenter matched cohort study comparing several procedural outcomes across FE, RE, and OS for ZD repair.</p><p><strong>Methods: </strong>The study population was matched for age, sex, American Society of Anesthesiologists score, and diverticulum. Size resulting in outcomes assessed included dysphagia scores, clinical and technical success, adverse events (AEs), procedure length, hospital length of stay, and need for further interventions. Both overall and pairwise comparisons were conducted. Subgroup analyses were performed to assess for comparative efficacy of FE procedure types, effect of previous intervention on procedure success, and the effect the year the procedure was performed on clinical success.</p><p><strong>Results: </strong>There were 202 eligible patients over the study period. Propensity score matching resulted in 125 patients (FE n = 44, RE n = 36, OS n = 45). FE demonstrated higher clinical success than RE (84.6% vs 55.6%, P = 0.032) and similar success to OS (88.9%, P = 0.712); OS showed higher success than RE ( P = 0.014). AE rates were lowest with FE (4.5%) compared with RE (8.3%) and OS (11.1%) although this was not statistically significant ( P = 0.212). FE had shorter median length of stay (0 days vs 1 day for RE and 3 days for OS, P < 0.001) and median procedure lengths (55 minutes vs 58 minutes for RE and 78 minutes for OS, P = 0.018).</p><p><strong>Discussion: </strong>In this matched cohort, FE has clinical success comparable with OS and superior to RE for ZD repair, with shorter hospital stays, reduced procedure lengths, and a trend toward fewer AEs. Our matched, multicenter design provides stronger comparative evidence than previous unmatched studies. These findings support FE as a first-line treatment of ZD repair, although prospective studies could further clarify long-term outcomes.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2393-2400"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}